New report outlines urgent need and opportunities in low- and middle-income countries where disease outbreaks most often strike

Robust clinical research capacity in low- and middle-income countries is key to stemming the spread of epidemics, according to a new report from the International Vaccines Task Force (IVTF).

The report, entitled Money and Microbes: Strengthening Research Capacity to Prevent Epidemics, lays out how to develop the political support, financing and coordination required to build this capacity as a crucial component of global epidemic preparedness. The IVTF was convened by the World Bank Group (WBG) and the Coalition for Epidemic Preparedness Innovations (CEPI) in October 2017.

There have been many global and country-level efforts to strengthen pandemic preparedness and response since the deadly West African Ebola outbreak in 2014-2015 that killed 11,000 people—and the last few weeks have provided evidence of this.

During the current Ebola outbreak in the Democratic Republic of Congo (DRC) with 49 total cases and 26 deaths so far, the government of DRC has approved the use for trials starting this week of a new, as-yet unlicensed Ebola vaccine, the rVSV-ZEBOV. The vaccine has proven highly effective in a clinical trial conducted in Guinea in 2015. Nigeria had its worst Lassa Fever outbreak on record earlier this year, and also pushed forward with conducting clinical trials as the outbreak unfolded.

“Times of crisis present the opportunity to focus capabilities and energy on solving important problems,” said Marie-Paule Kieny, Director of Research at INSERM and co-chair of IVTF. “Robust clinical research capacity is the only way to ensure that we don’t face future outbreaks with the same knowledge gaps over and over again.”

Of the 96 countries that have conducted vaccine trials in the past 20 years, 56 have conducted only between 1 and 10 trials, according to a registry maintained by the World Health Organization (WHO). This is insufficient to advance promising new vaccines, therapeutics and diagnostics for epidemic infectious diseases at the scale that is needed. The report recommends building capacity at a national or regional level that can flexibly scale up to run clinical trials during outbreaks, and focus on ongoing high-priority disease research based on local needs in between outbreaks.

“There are now more robustly trained local researchers working in better equipped facilities in low- and middle-income countries, but their numbers remain far too limited,” said Richard Sezibera, Member of the Senate, Rwanda, and Co-chair of the IVTF. “We must urgently prioritize clinical research both to save lives in low-income settings, and to generate valuable information that is a global public good.”

Besides improving health outcomes, clinical research offers a strong return on investment—publicly-funded research and innovation delivers about a 20 percent annual return on investment, compared with an average of 6.8 percent for the S&P 500, which includes the 500 largest companies listed on the U.S. stock market, according to Science Business.

“Investment in strong clinical research capability is a win-win, paying for itself many times over,” said Tim Evans, Senior Director and head of the Health, Nutrition and Population Global Practice at the World Bank Group. “It saves lives and improves health, drives innovation, and creates high-quality jobs, and also builds global health security from the ground up, making us all safer.”

The IVTF recommends that low- and middle-income countries commit domestic financing to this agenda, building political support and a research-friendly culture. It recommends that WHO develops a global tool and robust indicators for assessing country research capacity, and that the WBG creates an investment framework for national and regional clinical research capacity, using many of its unique financing mechanisms to link clinical research to its overall investments in pandemic preparedness. IVTF also recommends strong private sector engagement through transfer of skills and expertise as well as financing.

“Closing the clinical research gap is essential to ensure that we have the capacity that can be mobilized quickly and effectively whenever and wherever it is needed during outbreaks,” said Richard Hatchett, CEO of CEPI. “Without this, we will not be better prepared for and able to response to current and future epidemic threats.”